PTSD Nightmares in Youth May Be Treatable With Prazosin

Symptoms such as nightmares and hypervigilance in PTSD are thought to be related to noradrenergic hyperactivity, suggesting the effectiveness of prazosin.

Researchers have found that prazosin shows promising outcomes in treating nightmares in children and adolescents with posttraumatic stress disorder (PTSD), although it has not been well studied. These findings were presented at the American Psychiatric Association (APA) 2017 Annual Meeting in San Diego, California.

Adefolake Akinsanya, MD, resident at the MetroHealth System in Cleveland, Ohio, and colleagues conducted a search of the PubMed, Medline, Embase, Cochrane Collaboration, and PsycINFO databases for studies evaluating prazosin for treating nightmares in children or adolescents with PTSD. They identified 9 studies, 6 of which were case reports.

Although all the studies agreed that pharmacotherapy for PTSD in children is not well established, several published studies have found pharmacotherapy to be very effective for treating nightmares in adults with PTSD.

All the case reports showed a marked improvement in nightmares when prazosin was prescribed to children, although typically it was prescribed at lower doses than in adults, between 1 and 4 mg per day. In 3 of the case reports, after prazosin had caused remission of nightmares, the intensity and frequency of nightmares increased after prazosin was discontinued.

"Symptoms such as nightmares and hypervigilance in PTSD are thought to be related to noradrenergic hyperactivity, suggesting the effectiveness of prazosin, a centrally acting α-1 adrenergic antagonist, in reducing the intensity and frequency of PTSD-related symptoms," the researchers wrote.

They concluded that these studies show promising outcomes in prazosin's effectiveness in treating nightmares in children and adolescents with PTSD, but that further placebo-controlled trials are needed to assess the safety and efficacy of this treatment in children and adolescents.